AMNA NAWAZ: The makers and distributors of opioid painkillers have begun to pay out more than $50 billion to state and local governments across the nation.

Last night, we reported on how North Carolina is starting to spend its share of those payments.

Tonight, we traveled to Ohio, a state that has one of the highest overdose death rates in the nation.

But, as special correspondent Cat Wise and producer Mike Fritz report, the money has led to both a legal battle and questions about who's being left out of the process.

It's part of our ongoing series America Addicted.

CAT WISE: Three times a week, Jackie Lewis goes where no mother wants to go, to her son's grave in Jerome, Ohio.

JACKIE LEWIS, Mother: I always believed in him, even on the worst days.

CAT WISE: Shaun Lewis was 34 years old when he passed away last fall from a fentanyl overdose in Jackie's Columbus home.

Today, Jackie has come to bring new pictures, including of Shaun's 7-year-old daughter, Ava, and to clean the grave of a son she says was her best friend.

JACKIE LEWIS: He was always a prankster.

He was always a risk-taker.

He had a very kind, loving heart.

And he was very smart.

He had ambitions when he was young.

He wanted to be a scientist.

CAT WISE: But Jackie says Shaun's childhood wasn't easy.

He struggled with pain from scoliosis and, at 14, he was diagnosed with depression.

JACKIE LEWIS: In middle school, the doctor put him on four different pain medications, which, at the time I didn't know were addictive.

He didn't know.

CAT WISE: A 20-year battle with opioids followed, until October 19 of last year, when Shaun was found unresponsive in his room.

JACKIE LEWIS: And so I got down on my knees and he rolled over, and I heard air come out.

And it was just the last -- the last breath coming out of him.

CAT WISE: Jackie Lewis is now raising her granddaughter, Ava.

She says Ava's mother also died of a likely overdose three years ago.

Jackie's now sharing her family's story these days with anyone who'll listen.

LARRY KIDD, Chair, OneOhio Recovery Foundation: Unfortunately, Shaun died at a very young age of 34.

CAT WISE: That includes the members of this board, known as the OneOhio Recovery Foundation.

About once a month, this panel of state and local government leaders, addiction treatment experts and others gather in Columbus.

Their task?

To distribute 55 percent of Ohio's opioid settlement funds, expected to be about $2 billion over the next 18 years.

The rest will go directly to the state and local governments.

The foundation plans to start getting money out the door next year.

LARRY KIDD: Ohio will have the ability to preserve and deploy the resources to save lives in ways we never have in the past.

CAT WISE: This money comes at a critical moment for Ohio, a state that's losing about 5,000 people a year to drug overdoses.

GOV.

MIKE DEWINE (R-OH): It's torn up families all over the state of Ohio.

We have communities that have been devastated.

CAT WISE: Ohio's Governor Mike DeWine was one of the first in the nation to sue companies that made and distributed opioids.

He pushed for the creation of the OneOhio Recovery Foundation and appointed five of the 29 volunteer members, who represent regions across the state.

He says it was designed as a private nonprofit largely because of what happened to hundreds of billions of dollars won from tobacco settlements during the 1990s.

That money has mostly been used by state legislatures on programs unrelated to the prevention of smoking.

GOV.

MIKE DEWINE: So by setting up a nonprofit with the specific goal to deal with these problems, we are assured that that settlement money is in fact going to go toward this problem.

ANERI PATTANI, KFF Health News: So the council is the board of the foundation.

CAT WISE: Aneri Pattani of KFF Health News has been tracking how states across the country are spending their opioid settlement funds.

ANERI PATTANI: It's such a patchwork.

Every state is doing things differently.

And there are very few requirements for states to publicly report how they use this money.

CAT WISE: Ohio is one of two states, along with West Virginia, that created new private foundations to oversee the bulk of their settlement money.

It's an approach that Pattani says has raised concerns about whether the public will be able to participate in the process.

ANERI PATTANI: In Ohio, when the foundation started meeting and operating, it said: We're a private nonprofit.

We will choose to be public with our meetings and allow people to attend, but we don't have to.

And we don't have to follow public records laws and we don't have to follow open meetings laws, things that government boards do have to do.

DENNIS CAUCHON, President, Harm Reduction Ohio: So now you essentially have government officials spending government money and claiming they can do it all in secret because they are a private foundation.

CAT WISE: For 27 years, Dennis Cauchon was a journalist for USA Today.

Today, he runs the nonprofit Harm Reduction Ohio, a drug policy reform group.

DENNIS CAUCHON: This is drug overdose, intentional drug poisoning.

I track it every day.

CAT WISE: Last year, he says he was denied entry to the board's first meeting.

And when his request for records about how the board was operating went unanswered, he filed a lawsuit, citing language in the board's founding document that reads: "Meetings shall be open and documents shall be public to the same extent they would be if the foundation was a public entity."

DENNIS CAUCHON: They're covered by transparency laws, and they need to follow them.

CAT WISE: In May, Ohio's Supreme Court agreed, ruling unanimously that the foundation was required to follow public records laws and was performing a historically governmental function, the disbursement of public money.

GOV.

MIKE DEWINE: Afternoon, everybody.

CAT WISE: Last month, however, Governor DeWine signed budget legislation that states the foundation is not a state agency, exempting them from public records and open meeting laws going forward.

But DeWine pushes back on the idea the board isn't operating transparently.

GOV.

MIKE DEWINE: Every single meeting that OneOhio has is open to the public.

It's up on the Internet.

Anybody can watch it.

They're accountable.

And everybody can find out how the decisions are being made, but actually how that money is spent.

CAT WISE: But why not treat the foundation as a public entity?

I mean, what would be the harm of that?

GOV.

MIKE DEWINE: Well, because it's not a public entity.

If it is a public entity, you could have, candidly, a future legislature that decided, well, we're going to take this money and spend it on something else.

DENNIS CAUCHON: People who have lost loved one... CAT WISE: While his lawsuit plays out in court, Cauchon says the board is largely missing two crucial perspectives.

DENNIS CAUCHON: There is nobody on that 29-member state board who's lost a loved one to overdose.

That's unacceptable; 21 percent of opioid overdose deaths in Ohio are Black Ohioans.

I think they're adding one other member.

But, until now, only one member of the 29-member board has been a Black Ohioan.

LARRY KIDD: We don't pick our board members.

CAT WISE: Larry Kidd is an Ohio business owner and chair of the foundation.

LARRY KIDD: Regions pick their board members.

That's the majority of the board.

And they're also picked by the governor and the attorney general and the legislature.

So, while the diversity may not reflect the population, we're cognizant of that.

We do the very best we can to make sure that at least their voice is heard.

CAT WISE: Kidd also says several members of the board have been personally impacted by addiction.

LARRY KIDD: Whether they have gone through recovery issues or they have family members that have, it is not necessarily an issue people want to make public.

I personally have had issues within my own family that people aren't familiar with.

And that's one of the reasons I'm so passionate about the cause.

CAT WISE: But some on the front lines of Ohio's opioid crisis have felt left out of the process.

TRISH PERRY, OhioCAN: People who use drugs are not being included at all.

CAT WISE: Trish Perry is a county coordinator for OhioCAN, a nonprofit started by family members of individuals battling addiction.

Every Saturday, they hand out food, clothing, and the overdose-reversal drug Narcan in Newark, Ohio.

TRISH PERRY: Fentanyl testing strips?

CAT WISE: But Perry says her organization has so far encountered stigma and hurdles when applying for funding from opioid settlement money that's earmarked for local governments.

TRISH PERRY: If you don't supply people with clean use supplies and fentanyl testing strips, they die.

And if they die, they never get to be a productive citizen the in the community.

CAT WISE: It's a message Jackie Lewis hopes state leaders are hearing.

JACKIE LEWIS: I have to live every day just trying to figure out how to go on without him.

CAT WISE: She has met twice with members of the OneOhio Recovery Foundation and is pushing for families like hers to be reimbursed for funeral expenses and for kids like granddaughter Ava to also be compensated.

JACKIE LEWIS: Grandparents who were thrust into the role of raising grandchildren now, we don't know how long we will be around for their lives.

But these little children are the victims in this, and they need to have a chance.

CAT WISE: A chance for a different life amid a still-raging epidemic.

For the "PBS NewsHour" I'm Cat Wise in Columbus, Ohio.